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Flax V.L.,University of North Carolina at Chapel Hill | Siega-Riz A.M.,University of North Carolina at Chapel Hill | Reinhart G.A.,The Mathile Institute for the Advancement of Human Nutrition | Bentley M.E.,University of North Carolina at Chapel Hill
Maternal and Child Nutrition | Year: 2015

Inadequate energy intake and poor diet quality are important causes of chronic child undernutrition. Strategies for improving diet quality using lipid-based nutrient supplements (LNS) are currently being tested in several countries. To date, information on children's dietary intakes during LNS use is available only from Africa. In this study, we collected 24-h dietary recalls at baseline, 3, 6, 9 and 12 months on Honduran children (n=298) participating in a cluster-randomised trial of LNS. Generalised estimating equations were used to examine differences in number of servings of 12 food groups in the LNS and control arms, and multi-level mixed effects models were used to compare macro- and micronutrient intakes. Models accounted for clustering and adjusted for child's age, season and breastfeeding status. Mean daily servings of 12 food groups did not differ by study arm at baseline and remained similar throughout the study with the exception of groups that were partially or entirely supplied by LNS (nuts and nut butters, fats, and sweets). Baseline intakes of energy, fat, carbohydrates, protein, folate and vitamin A, but not vitamin B12, iron and zinc were lower in the LNS than control arm. The change in all macro- and micronutrients from baseline to each study visit was larger for the LNS arm than the control, except for carbohydrates from baseline to 9 months. These findings indicate that LNS improved the macro- and micronutrient intakes of young non-malnourished Honduran children without replacing other foods in their diet. © 2015 John Wiley & Sons, Ltd.


Ramakrishnan U.,Emory University | Nguyen P.H.,Thai Nguyen University | Gonzalez-Casanova I.,Emory University | Pham H.,Thai Nguyen University | And 8 more authors.
Journal of Nutrition | Year: 2016

Background: Maternal nutritional status before and during early pregnancy plays a critical role in fetal growth and development. The benefits of periconception folic acid (FA) supplementation in the prevention of neural tube defects is well recognized, but the evidence for preconception micronutrient interventions for improving pregnancy outcomes is limited. Objective: This study aimed to evaluate whether preconception supplementation with weekly iron and folic acid (IFA) or multiple micronutrients (MMs) improves birth outcomes compared with FA alone. Methods: We recruited 5011 women of reproductive age in a double-blind, randomized controlled trial in Vietnam and provided weekly supplements containing either 2800 μg FA, 60 mg Fe and 2800 μg FA (IFA), or the same amount of FA and iron plus other MMs until they conceived (n = 1813). All pregnant women received daily IFA through delivery, and were followed up for birth outcomes, including birth weight, gestational age, preterm delivery and small for gestational age (SGA). Group comparisons were done with the use of ANOVA or chi-square tests for both intention-to-treat (n = 1599) and per-protocol analyses (women consumed supplements ≥26 wk before conception; n = 824). Effect modification by baseline underweight or anemia status was tested with the use of generalized linear models. Results: The mean age of the women was 26 y, 30% were underweight, and < 10% were nulliparous. The groups were similar for most baseline characteristics. The mean 6 SD duration of the preconception intervention was 33 6 25 wk and compliance was high (> 90%). Infants born to the 3 groups of women did not differ (P≥ 0.05) onmean6 SD birth weight (3076.8 6 444.5 g) or gestational age (39.26 2.0wk), or prevalence of SGA (12%), low birth weight (5%) and preterm delivery (10%). Therewere no significant differences in women who consumed supplements ≥26 wk before conception or by baseline underweight or anemia. Conclusion: Weekly supplementation with MMs or IFA before conception did not affect birth outcomes compared with FA in rural Vietnamese women. © 2016 American Society for Nutrition.


PubMed | The Mathile Institute for the Advancement of Human Nutrition, Thai Nguyen University, Global Alliance for Improved Nutrition, Emory University and 2 more.
Type: Journal Article | Journal: The Journal of nutrition | Year: 2016

Maternal nutritional status before and during early pregnancy plays a critical role in fetal growth and development. The benefits of periconception folic acid (FA) supplementation in the prevention of neural tube defects is well recognized, but the evidence for preconception micronutrient interventions for improving pregnancy outcomes is limited.This study aimed to evaluate whether preconception supplementation with weekly iron and folic acid (IFA) or multiple micronutrients (MMs) improves birth outcomes compared with FA alone.We recruited 5011 women of reproductive age in a double-blind, randomized controlled trial in Vietnam and provided weekly supplements containing either 2800 g FA, 60 mg Fe and 2800 g FA (IFA), or the same amount of FA and iron plus other MMs until they conceived (n = 1813). All pregnant women received daily IFA through delivery, and were followed up for birth outcomes, including birth weight, gestational age, preterm delivery and small for gestational age (SGA). Group comparisons were done with the use of ANOVA or chi-square tests for both intention-to-treat (n = 1599) and per-protocol analyses (women consumed supplements 26 wk before conception; n = 824). Effect modification by baseline underweight or anemia status was tested with the use of generalized linear models.The mean age of the women was 26 y, 30% were underweight, and <10% were nulliparous. The groups were similar for most baseline characteristics. The mean SD duration of the preconception intervention was 33 25 wk and compliance was high (>90%). Infants born to the 3 groups of women did not differ (P 0.05) on mean SD birth weight (3076.8 444.5 g) or gestational age (39.2 2.0 wk), or prevalence of SGA (12%), low birth weight (5%) and preterm delivery (10%). There were no significant differences in women who consumed supplements 26 wk before conception or by baseline underweight or anemia.Weekly supplementation with MMs or IFA before conception did not affect birth outcomes compared with FA in rural Vietnamese women. The trial was registered at clinicaltrials.gov as NCT01665378.


PubMed | International Food Policy Research Institute, The Mathile Institute for the Advancement of Human Nutrition, Thai Nguyen University, Micronutrient Initiative and Emory University
Type: Journal Article | Journal: PloS one | Year: 2016

Preconception micronutrient interventions may be a promising approach to reduce anemia and iron deficiency during pregnancy, but currently we have limited data to inform policies. We evaluated whether providing additional pre-pregnancy weekly iron-folic acid (IFA) or multiple micronutrient (MM) supplements compared to only folic acid (FA) improves iron status and anemia during pregnancy and early postpartum.We conducted a double blind randomized controlled trial in which 5011 Vietnamese women were provided with weekly supplements containing either only 2800 g FA (control group), IFA (60 mg Fe and 2800 g FA) or MM (15 micronutrients with similar amounts of IFA). All women who became pregnant (n = 1813) in each of the 3 groups received daily IFA (60 mg Fe and 400 g FA) through delivery. Hematological indicators were assessed at baseline (pre-pregnancy), during pregnancy, 3 months post-partum, and in cord blood. Adjusted generalized linear models were applied to examine the impact of preconception supplementation on anemia and iron stores, using both intention to treat and per protocol analyses (women consumed supplements 26 weeks before conception).At baseline, 20% of women were anemic, but only 14% had low iron stores (ferritin <30 g/L) and 3% had iron deficiency (ferritin <12 g/L). The groups were balanced for baseline characteristics. Anemia prevalence increased during pregnancy and post-partum but was similar among intervention groups. In intention to treat analyses, prenatal ferritin was significantly higher among women receiving MM (geometric mean (g/L) [95% CI]: 93.6 [89.3-98.2]) and IFA (91.9 [87.6-96.3]) compared to control (85.3 [81.5-89.2]). In per protocol analyses, women receiving MM or IFA had higher ferritin 3 months postpartum (MM 118.2 [109.3-127.8]), IFA 117.8 [108.7-127.7] vs control 101.5 [94.0-109.7]) and gave birth to infants with greater iron stores (MM 184.3 [176.1-192.9]), IFA 189.9 [181.6-198.3] vs control 175.1 [167.9-182.6]).Preconception supplementation with MM or IFA resulted in modest increases in maternal and infant iron stores but did not impact anemia. Further research is needed to characterize the etiology of anemia in this population and identify effective interventions for reducing prenatal anemia.ClinicalTrials.Gov NCT01665378.

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